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World Multiple Sclerosis (MS) Day is set for 30 May, with the aim of raising awareness among the public and government agencies about the huge challenges faced by people affected by the disease.

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What is multiple sclerosis?

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Multiple Sclerosis (MS) or MS is a chronic immune-induced inflammatory disease of the central nervous system (CNS). It affects the sheath of neurons, leading to varying degrees of damage, mainly to myelin. For this reason, it is classified as a demyelinating disease.

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Although there is as yet no "radical" cure for MS, there are now several drugs that significantly reduce the incidence of flares and prevent the accumulation of neurological deficits.

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Epidemiology

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Multiple Sclerosis occurs most often in people aged 20-40 years. It is more common in women than in men, in a ratio of 3 to 1. It is rarely diagnosed in children or in people over 65 years of age. It is estimated that around 2.5 million people worldwide suffer from the disease.

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What are the types of multiple sclerosis?

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Each form of Multiple Sclerosis varies in severity and symptom pattern and is characterised by a different histopathological substrate. It is divided into four types:

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Intermittent/Recurrent form (RRMS)

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It affects 85-90% of patients. In this form there are flares, which are partially or fully recovered from periods of remission.

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Secondary product form (SPMS)

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It concerns patients with an initially intermittent form of the disease, who, over the years, present a slowly deteriorating clinical picture.

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Primary Product Form (PPMS)

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It affects 10-15% of patients, who from the beginning show a progressive clinical deterioration, without remissions and exacerbations.

Progressive relapsing form (PRMS)

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Rare form, in which flares occur during a progressive deterioration since the onset of the disease.

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How is it caused?

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Disruption of the immune system is considered the predominant aetiology of the disease, causing the alteration of the blood-brain barrier and the entry of lymphocytes into the CNS with toxic effects.

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The process of autoimmune attack leads to the creation of foci of inflammation within the CNS and eventually to the partial destruction of myelin. Myelin is the protective sheath of the nerve cell processes (the neurons) and is formed by specialised cells called oligodendrocytes. Its role is to protect and accelerate the electrical transmission of nerve impulses. Therefore, when inflammation destroys myelin, the conduction of nerve impulses is blocked and the communication system of brain cells is disrupted.

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Over time, the affected areas change in texture and become hard, forming what are known as "plaques" - hence the name "MS". Depending on the area where they are located, they can affect the patient's movement, touch or other senses.

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What are the causes?

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Many factors have been implicated, but the cause that triggers the immune response of the disease is not known. A general explanation is that it is due to a combination of genetic and environmental factors. Theories have been put forward linking multiple sclerosis to genetic and toxic-environmental factors (vitamin D deficiency, smoking, EBV infection), but nothing is absolute. Heredity also has a small role in the causes.

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What are the symptoms?

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The disease may present with different symptoms, depending on the location and extent of the lesion. One of the most common initial manifestations is optic neuritis, which leads to loss of vision, often with accompanying pain. Also, common initial symptoms of the disease include:

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Numbness ("numbness") in various parts of the body

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Lhermitte's point (feeling of electrical discharge along the spine, caused by bending the head)

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Weakness of one limb

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More rarely, the disease can occur with:

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Dizziness

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Diplopia

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Disorders of urination

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Peripheral facial nerve palsy

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Trigeminal neuralgia

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Generally, as the disease progresses, various disorders may occur, such as:

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Sensory disorders

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Vision disorders

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Movement disorders

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Mood disorders

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Mental disorders

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Speech disorders

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Balance and gait disorders

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In general, the progression of multiple sclerosis varies considerably depending on the patient. Some individuals develop minimal neurological deficits during their lifetime, while others are left with significant disability.

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How is the diagnosis made?

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Diagnosis begins with the history and neurological examination and is confirmed by MRI and lumbar puncture.

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What is the treatment?

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Unfortunately, there is no cure that can remove or prevent the cause of the disease. Thus, the aim is to restore the impaired neurological functions, avoid new relapses and generally limit disability for as long as possible.

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It is very important to establish a relationship of trust between the patient and the doctor, as well as the patient's compliance with the treatment. Also, for best results, it is necessary to have the cooperation of doctors of different specialties.

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More specifically, the treatment includes :

Medication

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Drugs are divided into two categories, immunosuppressants and immunomodulators. Immunosuppressants include corticosteroids, which aim to reduce the acute symptoms. Immunosuppressive therapies are aimed at long-term prevention of relapses. These cytotoxic treatments, however, have serious haematological and cardiological side effects, so the patient must be under constant monitoring. Drugs are also given to relieve troublesome symptoms such as spasticity, fatigue and pain.

The rehabilitation of the patient through occupational therapy, speech therapy, movement therapy and psychological support, with the aim of achieving the patient's functional independence.

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Adopting a healthy lifestyle with a balanced diet, physical exercise and avoiding stress.

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Inference

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Patients with multiple sclerosis can live a normal life, through early diagnosis and personalised treatment, without being excluded from society and certainly without bearing the heavy stigma of disability.

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References

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https://www.neurocenter.gr/sklirinsi.html

https://neyrologos.gr/sklirinsi-kata-plakas-ti-einai-morfes-ilikia-emfanisis/

https://www.iatriko.gr/el/disease/pollapli-sklirynsi-i-sklirynsi-kata-plakas?cl=609

https://www.novartis.com/gr-el/patients-and-caregivers/diseases/multiple-sclerosis

https://www.sanofi.gr/el/gnoriste-mas/therapeftikes-katigories/polapli-sklirinsi

https://www.hygeia.gr/services/department/pollaplis-sklirynsis-apomyelotikon/

https://www.euromedica.gr/πολλαπλή-σκλήρυνση-σκλήρυνση-κατά-πλ/

https://neurologos-thess.gr/πολλαπλή-σκλήρυνση

https://www.poamskp.gr/ti-einai-i-pollapli-sklirynsi/morfes-tis-pollaplis-sklirynsis/